DDW: Fatty Liver Can Lead to Liver Cancer, Cleveland Clinic reports at DDW

Clinic study links liver disease to cancer

Tuesday, June 02, 2009
Angela Townsend
Plain Dealer Reporter

People who suffer from the most serious form of nonalcoholic fatty liver disease have a significant risk of developing liver cancer, researchers at the Cleveland Clinic have found.

The findings were presented Monday at Digestive Disease Week in Chicago, the largest annual gathering of professionals in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

Nonalcoholic fatty liver disease is the most common liver disease in the United States. Obesity, along with hypertension and diabetes, is a major risk factor. For some time, physicians have adopted different strategies such as gastric bypass surgery, diet and exercise to slow down or even reverse the disease.

The disease is so named because of the accumulation of fat in the liver - without an excessive amount of alcohol as the cause. The liver also becomes inflamed and scarred.

Researchers looked at patients with the most serious form of the disease, nonalcoholic steatohepatitis, or NASH. About 20 percent of patients with NASH go on to develop cirrhosis of the liver. (Cirrhosis of the liver is also caused by alcohol abuse - which accounts for most cirrhosis cases - and other conditions such as hepatitis B and C.)

"We suspected that having cirrhosis from fatty liver disease would lead to liver cancer, but that wasn't defined before," said Dr. Nizar Zein, the Clinic's chief of hepatology and medical director of liver transplantation.

The research was conducted by Mustafa Ascha, a student at Case Western Reserve University for whom Zein serves as a mentor.

It wasn't until the 1980s that much was known about fatty liver disease. And until recently, alcohol was blamed as the sole cause.

Cirrhosis of the liver causes hepatocellular carcinoma, the most common form of liver cancer and the fifth most common cancer worldwide.

The Clinic study followed 510 patients with liver cirrhosis from 2003 to 2006. About 38 percent (195) suffered from NASH. The other 62 percent had hepatitis C.

The two goals were to see if patients would develop liver cancer, and if that risk could be quantified.

The answers were "yes" and "yes."

Nearly 13 percent of the NASH patients developed cancer over the course of the study.

Per year, 2.6 percent of the patients developed liver cancer. If that pattern holds true, more than one-fourth (27 percent) will develop liver cancer after 10 years, Zein said.

In comparison, about 20 percent of the hepatitis patients developed liver cancer, at an annual rate of 4 percent per year.

But a diagnosis of liver cancer isn't necessarily an automatic death sentence. Found early, it can be treated, Zein said.

Those at highest risk for liver cancer are older people and people who drink alcohol, even in small quantities.

Zein said he counsels fatty liver disease patients to avoid alcohol completely, but added the opinion is not "universal."

The Clinic is one of only a few institutions that have followed a large population of people with the disease. To date, the Clinic's study is the largest, Zein said.

Measuring the cancer risk not only will raise awareness about the dangers of nonalcoholic fatty liver disease, but also will help physicians decide how often people with the disease should be screened for cancer, Zein said.